The forensic pathology department received the case of a 66-year-old woman with a history of arterial hypertension, fibromyalgia and myasthenia gravis diagnosed 20 years previously. She was under chronic antihypertensive treatment with amlodipine (10 mg/24 h), furosemide (40 mg/24 h) and losartan postassium (50 mg/24 h), anxiolytic - antidepressant with duloxetine (30 mg/24 h) and amytriptyline hidorchloride (10 mg/24 h), treatment for osteoporosis with calcifediol (800 mg/24 h) and gastric protection with omeprazole (20 mg/24 h). One week before death, she consulted the emergency department for catarrhal symptoms that were treated with ciprofloxacin and carbocisteine, with improvement of the respiratory symptoms. Two days before his death, he consulted the emergency department again because of general weakness, which was attributed to the antibiotic treatment and the discontinuation of the treatment was indicated. There were no symptoms of headache and/or other symptoms of neurological focality in her clinical history.
The patient died suddenly and her husband reported dyspnoea as the only symptom prior to death.
During the autopsy the most remarkable findings were the following:
Height of 149 cm, weight of 80 kg and Body Mass Index of 36 kg/m2, which corresponded to type II obesity. Other notable findings on external examination were hirsutism, mid-thoracotomy scar as a consequence of thymectomy for the treatment of myasthenia gravis and oedema of the lower extremities. As external signs of violent cause, a recent right buttock haematoma was found, compatible with the fall she suffered during the perimortal period and with the sitting position on the floor in which she was found during the body removal.
The most relevant findings of the internal examination were a coagulated haemopericardium of 200 g, the heart weighed 400 g (expected weight 320 g) and we observed a 0.5 cm tear in the middle anterior part of the left ventricle due to transmural infarction secondary to coronary atheromatosis of the three vessels, more marked in the middle third of the anterior descending artery where it obstructed the vascular lumen by more than 75%.
In the skull, the presence of internal frontal hyperostosis was notable, less marked in the parietal area. The thickness of the unaffected diploe was 8 mm, while in the areas of hyperostosis the thickness ranged from 1.5 mm to 2.3 mm. In addition, multiple calcified meningiomas were found following the superior longitudinal sinus, most of them nodular in shape and some of them smaller, spiculated and plaque-like. At the cerebral level, a slight depression of the surface of both frontal lobes was observed.

The rest of the autopsy findings were not significant and the results of the toxicological analysis were negative. The histopathological study was concordant with the macroscopic data of internal frontal hyperostosis and the meningiomas were calcified psammomatous.